Introduction Metacarpal and phalangeal fractures are common upper limb fractures due to direct blows, axial loading, and torsional loading injuries. The universal goal in treating all fractures for the patient to achieve normal motion, but the ideal technique for stabilization is still debated. For internal fixation, Kirschner wires (K-wires) or miniplates can be used, and each carries certain advantages. No previous study has compared K-wire use to miniplate use in treating metacarpal and phalangeal fractures. Therefore, we conducted this randomized control trial to evaluate the outcomes of K-wire and miniplate use in treating metacarpal and phalangeal fractures. Materials and methods This randomized controlled trial was conducted in the Department of Orthopaedic Surgery, Bahawal Victoria Hospital, from February 2017 to February 2018. Seventy-five patients were included in this study and randomly assigned into two groups. One group was treated with Kwire fixation, and the other group was treated with miniplate fixation. We assessed total active motion (TAM), range of motion (ROM), duration of injury, and complication rate. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Armonk, NY: IBM Corp). P values ≤ 0.05 were considered significant. Results Mean surgical time, pain scale, and time of union of K-wire treated patients was 38.63±3.64 minutes, 4.17±1.11, and 12.95±3.38 weeks, respectively. The success of the union was noted in 38 K-wire patients (95%). Total active ROM was greater in miniplate fixation patients compared with K-wire treated patients, but this difference was statistically significant. Similarly, TAM was also greater in the miniplate fixation patients compared to the K-wire treated patients, but this difference was also not statistically significant. Conclusion Both K-wire fixation and miniplate fixation are equally effective in terms of TAM, ROM, and complications when used to treat metacarpal and phalangeal fractures.
Finite fields are well-studied algebraic structures with enormous efficient properties which have applications in the fields of cryptology and coding theory. In this study, we proposed a lossless binary Galois field extension-based efficient algorithm for digital audio encryption. The proposed architecture hired a special type of curve in the diffusion module which depends on efficient elliptic curve arithmetic operations. So, it generates good quality pseudo-random numbers (PRN) and with slight computational efforts, it produces optimum diffusion in the encrypted audio files. For the confusion module, a novel construction mechanism of block cipher has been employed which includes prominent arithmetic operations of binary Galois field inversion and multiplication operations. The suggested scheme generates multiple substitution boxes (S-boxes) by using a higher-order Galois field. Thus, the replacement with multiple S-boxes generates effective perplexity in the data and provides additional security to the ciphered audio. The investigational outcomes through different analyses and time complexity demonstrated the ability of the technique to counter various attacks. Furthermore, as a consequence of a rapid and simple application of the binary finite field in hardware and software, the proposed scheme is more appropriate to be applied for data security.
Objective: Aim of current study was to determine the functional outcomes of closed static intramedullary nailing with distal two plane locking versus percutaneous MIPPO distal tibial locking plate in distal 3rd tibia metaphyseal fractures. Study Design: Randomized clinical trial Place and Duration: Nishtar Hospital Multan/Qaisrani Medical Center Multan. Jan 2021-March 2022 Methods: There were 76 patients of both genders with age 15-60 years presented. All the patients had 3rd tibia metaphyseal fracture were admitted to hospital for surgery. Following the collection of informed written consent from enrolled patients, complete demographic information was gathered. Patients were equally divided into two groups. Group I received intramedullary nailing with distal two plane locking and group II received percutaneous MIPPO distal locking plate. Favorable and unfavorable outcomes among enrolled cases were compared. SPSS 22.0 was used to analyze all data. Results: There were majority males 22 (60.5%) in group I and 20 (52.6%) in group II. In group I mean age was 30.8±6.42 years with mean BMI 24.71±3.19 kg/m2 and in group II mean age was 31.14±3.58 years and had mean BMI 25.7±7.17 kg/m2. Falling, accidents, sports and lifting of heavy object was the most common cause of fractures. We found that intramedullary nailing was more effective as compared to MIPPO distal locking plate in terms of functional outcomes but difference was insignificant. Frequency of complications were higher in group II found in 14 (36.8%) as compared to group I in 4 (10.4%) cases. Conclusion: We concluded in this study that distal third tibial metaphyseal fractures were effectively operated by intramedullary nailing distal two plane locking and MIPPO distal locking plate but frequency of complications were higher in MIPPO group as compared to intramedullary nailing. Keywords: Metaphyseal Fractures, MIPPO Distal Platting, Intramedullary Nailling, Functional Outcomes, Complications
Objective: To compare midvastus and subvastus approach regarding operative parameters(lateral retinacular release, operative time, neurovascular injury) and outcome (Knee Society Score, Straight Leg Raise) at 12 weeks in single stage bilateral total knee arthroplasty. Study Design: Randomized clinical trial study Place and Duration of Study: Institute of Orthopaedic Surgery and South City Hospital Karachi from 1st January 2016 to 31st December 2018. Methodology: Fifty two patients of both genders ofmore than 50 years with osteoarthritis grade III or IV and bony changes confirmed by AP and lateral radiographs of knee were included. Patients with previous knee surgeries including high tibial osteotomy, deformities >20°(on mechanical axis), any neuromuscular problem and BMI ≥30 were excluded. Final assessment was done at 12 weeks. Isometric quadriceps strength was assessed by holding of contraction in seconds during the lifting (10cm above the plinth) phase of SLR (patient lying supine).Knee score (preoperative and final follow-up) was performed by Knee Society Score. Results: Thirty five were females and 21 males with mean age 65.3 years (50-78 years). Mean body mass index was 27.8 Kg/m2 (26.4-29.9). In midvastus TKR, the mean operative time was 61.7 minutes (range 52-70) whereas the same was 68.3 minutes (range 58-74) in subvastus TKR with p value 0.002. Rate of lateral retinacular release (LLR) was significantly (p=0.011) different between the midvastus TKR 5 (8.9%) and subvastus TKR 11 (19.6%). Neither group had neurovascular injury or early infection of the knee. Active SLR in subvastus group was achieved in shorter time (mean 3.1 days) as compared to midvastus group (mean 4.7 days). There was no difference (p=0.173) in isometric quadriceps strength at 12 weeks between subvastus TKR (mean 18 seconds) and midvastus TKR (mean 17 seconds). Knee society pain and functional scores were comparable between the two approaches at final follow up. Conclusion: Subvastus exposure has advantage of achieving active straight leg raise earlier while midvastus has lower frequency of lateral retinacular release. No difference in hospital stay and postoperative pain scores. Both subvastus and midvastus approaches are safe and offer comparable Knee Society Score outcomes. Keywords: Midvastus, Subvastus, Total knee arthroplasty, Knee Society Score, Straight leg raise
… Background: Tibial fractures is most common type of long bone fractures. High speed lifestyles with vehicles motorcycles as well as growing waves of violence, contributing increase occurrence of tibial fractures. Tibial plateau fractures continues to be a challenge for orthopedic surgeon. Treatment of these fractures have been plagued by complications. Recent improvements in the techniques and development of hybrid external fixator have revolutionized the treatment of such fractures. Objective: To evaluate the clinical outcomes of hybrid external fixator in high energy Schatzkar V and VI tibial plateau fractures. Study Design: Descriptive, Case series. Period: 27 June 2013 to 26 June 2016. Setting: Nishtar Hospital, Multan. Material and methods: A total of 125 patients with open and close tibial plateau fractures, 20 to 50 years of age of both genders were included in the study. Patients having history of pervious surgery or intervention tibial plateau fractures, and h/o malignancy were excluded. All the patients were operated by a consultant orthopedic surgeon. Outcome was assessed at 16 weeks by serial radiological x-ray by formation of callus and noting any grade of pin track infection. Results; Our study comprised of 125 patients having Schatzker V and Schatzker VI tibial plateau fractures who met our inclusion criteria. Mean age of 38.925 ± 7.09 years. Majority of the patients 47 (37.60%) were between 41 to 50 years of age. Mean duration since injury in our study was 13.18 ± 4.79 hours. Out of 125 patients, 102 (81.60%) were males and 23(18.40%) were females with male to female ratio of 1.2:5.4. Fifty three (42.4%) patients presented with Schatzker V and 72 (57.6%) had Schatzker VI type of tibial plateau fractures. In our study, non-union was seen in 10cases (8.0%) and pin track infection was noted to be present in 19 (15.20%) patients. So, the acceptable outcome (achievement of union without non-union or pin track infection during 16 weeks) was seen in 96(76.8%) patients. Conclusion: This study concluded that there is high rate of acceptable outcome (achievement of union without any non-union or pin track infection during 16 weeks) after hybrid external fixator of the open and closed fractures of tibial plateau among the patients having schatzker-V and VI.
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